The Centers for Disease Control and Prevention estimates that 20 percent of high school students smoked cigarettes last year. Smoking rates among ninth- to 12th-graders have remained stable for the past five years.

"When I see a young kid smoking, it's just so frustrating because I actually know the power of tobacco to cause disease," said Dr. Otis Brawley, chief medical officer for the American Cancer Society.

Nearly half of all adults in the United States who suffer from emphysema and 40 percent with chronic bronchitis are smokers, the CDC reports.

More than 430,000 Americans die each year from smoking-related causes, the American Lung Association estimates.

While researchers have a good idea how to help adults kick the habit, little information is available on what to do to assist teenage smokers.

"It's really hard for somebody who is a teenager in high school to stop smoking, even if they wanted to stop smoking," Brawley said.

Marcheski called the success rate at her school outstanding. "Thirty-seven percent of kids have quit and 60 percent reduced the number of cigarettes smoked," she said.

This particular session was called "quit day."

Cassie and her classmates talked openly about their reasons for wanting to quit. Almost everyone mentioned health concerns and the expense of the habit.

David Thomas, 18, added "I want to smell better. I won't have to use cans and cans of Axe. I can work out longer and I don't have to worry about carrying mints around."

Lia Pisa-Relli said she started smoking when she was 12. Now at the age of 17, she worries that she has a lot of breathing problems. "I want to be able to run. I can't even run up the stairs. I can't even walk up two flights of stairs. It's pretty bad."

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The counselors spoke with the teens about how to handle nicotine withdrawal symptoms. They passed out lollypops and stress balls to take their mind off cravings. They urged the students to lean on one another and their families for support.

Their final exercise of the day was to write down their concerns and fears about quitting on note cards.

Cassie read her comments aloud to the group: "One of my biggest concerns was that I wouldn't be able to quit, but now I know if I just stick to it and actually try hard to quit then I'll be able to."

She and her classmates crumpled up the cards and tossed them in the trash as if they were throwing away a bad habit.